Blog do Curso de Medicina da Universidade Estadual de Maringá para a discussão de temas de Educação Médica, Educação das Profissões da Saúde e áreas correlatas.
Blog of University of Maringá Medical School for the discussion of issues of Medical Education, Health Professions Education and related areas.

segunda-feira, 8 de junho de 2015

Serious games

Game Beats 'Old-School' Tools to Teach Insulin Prescribing

By Marlene Busko

BOSTON — In a randomized controlled trial
that pitted Brazilian primary-care physicians who learned about insulin
therapy via a game vs others who learned via traditional
continuing-medical-education lectures, both groups improved their
knowledge. But the "gamers" came out on top.

"We hope that our
game can be an excellent tool for continuing medical education," the
game's codeveloper, Dr Leandro A Diehl (Universidade Estadual de
Londrina, Brazil), told Medscape Medical News at a poster presentation at the American Diabetes Association (ADA) 2015 Scientific Sessions.
Because the game is available online, it can reach a large number of
physicians, he noted. "We hope to improve diabetes care with this
[educational tool]," he said.

The trial to assess the game's
effectiveness was part of Dr Diehl's PhD thesis; the game is currently
available only in Portuguese, but the researchers plan to have Spanish
and English versions available online in a few months.

A Canadian
endocrinologist who was passing by the poster said he looks forward to
playing this educational game. "I think it is a novel approach, and I'm
anticipating playing it," Dr Thomas Ransom (Queen Elizabeth II Hospital
Centre, Halifax, Nova Scotia) told Medscape Medical News.

"A
lot of what we do in continuing medical education is dry and comes from
tables and doesn't really represent real life," he said. "A game is
closer to real life than what comes off your standard slide deck."
Moreover, a game will bring out the competitive drive of physicians, Dr
Ransom added. "They want to do well, and a game would challenge them."

Fun, Effective, Practice-Changing Education

Worldwide,
primary-care physicians are the main providers of type 2 diabetes care,
yet they often lack expertise in this area, especially in the use of
insulin, according to Dr Diehl and colleagues. "Clinical inertia," or a
delay in starting patients on insulin, is a major contributor to poor
glycemic control, they note.

The group of clinical endocrinologists, medical educators, and game designers developed InsuOnLine,
an educational game to teach primary-care providers "basic rules about
providing insulin therapy" to patients with type 2 diabetes, Dr Diehl
explained.

"In the game, the player takes on the role of a young
physician in a primary healthcare clinic and must assess a series of
diabetic patients and decide what to do to improve their glycemic
control," usually by initiating or adjusting their insulin," Dr Diehl
explained. The cases represent the most typical patient presentations in
primary healthcare, he added.

The researchers randomized 135
primary-care physicians (including 52 residents) in southern Brazil to
receive education about insulin therapy from the the game (70
physicians) or from traditional instruction (65 physicians).

The physicians replied to a questionnaire to assess their baseline knowledge, skills, attitudes, and satisfaction.

Those
who were randomized to the "game group" played the InsuOnLine game,
which included patient-case scenarios, on their computers, at their own
speed. The physicians in the control group attended 3 to 4 hours of
traditional lectures with clinical-case discussions. The content of the
game and the lectures was similar and based on guideline recommendations
for insulin therapy.

The primary outcome was insulin-prescribing
skills and knowledge, as measured by a questionnaire. Secondary outcomes
were beliefs about insulin and satisfaction with the activities.

The physicians included 70 men (52%) and 65 women (48%), with a mean age of 38.

The
mean insulin-therapy-knowledge score (% of right answers) improved from
52% at baseline to 85% after the traditional education (P < .001), and to 92% after the game-based education (P <
.001). The mean improved score was higher in the group that received
game-based education than in the group that received traditional
education (P = .001).

Participants in both groups had more accurate beliefs about insulin following their education.

All
participants in both groups said that the activity increased their
knowledge of type 2 diabetes and would have an impact on their practice.
The game and the traditional education dispelled some misconception
about insulin therapy — for example, that it is better to delay insulin
initiation until it is absolutely essential.

Almost
all the participants (96%) found that the game was fun. Most
participants considered the game to be more effective than attending a
lecture to learn about insulin therapy.

"Our results show that a
well-designed digital game is very effective for medical education on
insulin," Dr Diehl and colleagues summarize. "Due to its flexibility of
use and easy dissemination, InsuOnLine has a great potential to improve
primary-care-physician skills for treating diabetes and to ameliorate
the care given to diabetic patients worldwide," they conclude.

Dr
Diehl is on the speaker's bureau of AstraZeneca and Bristol-Myers
Squibb and is co-owner of the InsuOnLine game. Disclosures for the
coauthors are listed in the abstract.